Youth Volunteer Registration

Here at RRBC, we love giving opportunities to all ages and stages to SERVE GOD! This form is for youth groups or teens who wish to serve God in a volunteer fashion at Raccoon River Bible Camp. It just gives us the information we need to make sure we have all our bases covered! We sincerely can’t wait to have you join us in serving God together at camp! Please fill out the form below!

Volunteer Name*

First

Last

Gender

Male

Female

Date of Birth*

day

/

month

/

year

Grade Entering*

Parent/Guardian*

First

Last

Mailing Address*

Street AddressCityState / Province / RegionPostal / Zip Code

Email*

Home Phone*

Cell Phone *

Work Phone*

Camp(s) Serving:*

Junior 1 (Grades 3-6)

Junior 2 (Grades 3-6)

WILDERNESS EXPERIENCE

Junior 3 - July 5-7 (Grades 3-6)

Junior High - July 9-14 (Grades 7-8)

Senior High - July 16-21 (Grades 9-12)

Starters - July 23-24 (Grades 1-2)

Church

Pastor

Church Address

Street AddressCityState / Province / RegionPostal / Zip Code

Family Doctor*

Doctor's Phone Number*

Insurance*

Insurance Policy #*

Medications (must be in original container)*

If medication is to be given, specific name/s of medication to be dispensed:

May we administer OTC medication such as Tylenol/Advil?*

Allergic reactions: Bee stings? Food? Other? Please explain.

Date of last tetnus shot (if applicable)? mm/dd/yy ie: 5/25/2016

By submitting my name below, I confirm that I am the parent/guardian of the volunteer named above. *

First

Last

RRBC's insurance policy is an accident only policy. It does not cover medical illness. In the case of an emergency, every attempt will be made to contact a parent/guardian. I give my permission for my child to attend RRBC, participate in it's activities, and for any pictures, videos, and testimonies of my child to be used in promotion of the camp. I also give consent for any medical treatment deemed necessary for my child named above.*